The effect of BMI at cancer diagnosis on survival of patients with head and neck carcinoma

Abstract Background Previous findings suggest a positive association between body mass index (BMI) and survival from head and neck cancer (HNC). The aim of this study is to investigate the prognostic role of BMI at the time of diagnosis in a large international cohort of HNC patients. Methods We performed a pooled analysis of studies included in the INHANCE consortium. Cases were adults with HNCs of the oral cavity, oropharynx, hypopharynx, and larynx. We used Cox proportional hazards models to estimate the adjusted hazard ratios (HR) for overall survival and HNC-specific survival, by cancer site. Subgroups analyses were performed according to smoking status and duration of follow-up. Results The study included 10,177 patients from 10 studies worldwide with a median follow-up of 48 months; 3654 patients (35.9%) died from all causes, including 1202 (11.8%) from HNC. Underweight patients had lower overall survival (HR = 1.69, 95% CI: 1.31-2.19) respect to normal BMI patients (BMI=18.5-24.9 kg/m2) with consistent results across the HNC sites. In HNC-specific mortality analyses, the survival for underweight patients was not significant, except for underweight patients with oropharyngeal cancer (HR = 1.43, 95% CI: 1.11-1.83). Overweight and obese patients for oropharyngeal cancers had a favourable HNC-specific survival (HR = 0.50 (95% CI: 0.33-0.75) and HR = 0.51 (95% CI: 0.36-0.72), respectively). Among never smokers, overall BMI status was not associated with HNC-specific survival. Among ever smokers overweight and obese categories showed a favourable HNC-specific survival (HR = 0.69 (95% CI: 0.56-0.86) and HR = 0.70 (95% CI: 0.61-0.80)). Conclusions Our findings show that high BMI values increase the survival rates in smoking patients with HNC, suggesting that a nutritional reserve may help patients survive HNC cancer. This effect, however, may be partly explained by residual confounding, reverse causation, and collider stratification bias. Key messages • Our analysis reports the results of the largest available pooled analysis on the prognostic significance of BMI in the survival of 10,177 HNC patients from 10 studies worldwide. • Lower overall survival was observed in underweight patients for all HNC sites and a lower HNC-specific survival was observed with oropharyngeal cancer. Adiposity could serve as a nutrient reserve.


Background:
Longer work careers are discussed, but inequalities in health trajectories among employees facing retirement remain poorly understood. We examined social class trajectories in physical functioning among ageing female employees ten years before and after transition to old-age or disability retirement.

Methods:
We used Helsinki Health Study cohort data. The baseline  included 7168 women, aged 40-60, employed by the City of Helsinki, Finland (response 67%). Follow-ups took place in 2007Follow-ups took place in , 2012Follow-ups took place in and 2017. The outcome was RAND-36 Physical Functioning subscale, range 0-100, with higher scores indicating better functioning. Social classes were upper and lower class, and covariates age, work conditions and health behaviours. Mixed-effect growth curve models were used to predict functioning scores and 95% confidence intervals (CI) 10 years before and after mandatory old-age or disability retirement.

Results:
Old-age and disability retirees lacked class inequalities in functioning 10 years prior retirement. Towards retirement transition, functioning declined and inequalities emerged. Among old-age retirees, the predicted score was 86.1 (CI 85.2-86.9) for upper class and 82.2 (81.5-83.0) for lower class. Among disability retirees, the score was 70.3 (67.8-72.9) for upper class and 62.2 (60.4-63.9) for lower class. Among oldage retirees, functioning declined and inequalities slightly widened. Among disability retirees, the decline plateaued and inequalities narrowed. Physical work and BMI somewhat attenuated the inequalities.

Conclusions:
Among female employees, functioning declined and class inequalities emerged towards retirement transition. Widening inequalities were seen among old-age retirees, but not among disability retirees. Preventing the decline of functioning and related inequalities would help safeguard a healthy and successful ageing among female retirees.
Key messages: As functioning shows a constant decline before and after old-age retirement, there is a need for slowing down the pace of the decline. Class inequalities in functioning tend to widen among oldage retirees; egalitarian measures are needed to turn the development to narrowing inequalities.

Background:
Previous findings suggest a positive association between body mass index (BMI) and survival from head and neck cancer (HNC). The aim of this study is to investigate the prognostic role of BMI at the time of diagnosis in a large international cohort of HNC patients.

Methods:
We performed a pooled analysis of studies included in the INHANCE consortium. Cases were adults with HNCs of the oral cavity, oropharynx, hypopharynx, and larynx. We used Cox proportional hazards models to estimate the adjusted hazard ratios (HR) for overall survival and HNC-specific survival, by cancer site. Subgroups analyses were performed according to smoking status and duration of follow-up.

Conclusions:
Our findings show that high BMI values increase the survival rates in smoking patients with HNC, suggesting that a nutritional reserve may help patients survive HNC cancer. This effect, however, may be partly explained by residual confounding, reverse causation, and collider stratification bias. Key messages: Our analysis reports the results of the largest available pooled analysis on the prognostic significance of BMI in the survival of 10,177 HNC patients from 10 studies worldwide. Lower overall survival was observed in underweight patients for all HNC sites and a lower HNC-specific survival was observed with oropharyngeal cancer. Adiposity could serve as a nutrient reserve. The COVID-19 pandemic, has begun a global changes in the mortality model, exceeding its predicted levels under standard conditions. The aim of the study was to assess the phenomenon of excess mortality in Poland in 2020 and in the first half of 2021 compared to 2016-2019 based on the data of the Central Statistical Office. The number of excess deaths was defined as the difference between the deaths in 2021 and the average number of deaths in the previous years. In accordance with the Eurostat methodology the 2016-2019 average was taken as the reference point. In 2020, the number of deaths in Poland amounted to 485,259 and was higher by 14.9% than expected on the basis of mortality in 2016-2019 (the absolute excess number of deaths amounted to 67,112). 43% of the excess deaths were deaths caused by Sars-Cov-2, 27% other deaths among infected people, and 30% deaths among those without confirmed infection. In this group, the highest increases were recorded for deaths due to cardiovascular diseases, neurological diseases and mental disorders. In the first half of 2021, 270,662 people died in Poland, i.e. 23.9% more than in the corresponding period in 2016-2019 and 22.9% more than in the first half of 2020, whereas 58,096 people died due to COVID-19 (22% of all deaths). The highest increases for non-viral deaths compared to 2016-2019 were recorded for blood diseases and immune mechanisms (121.53%), infectious and parasitic diseases (90.76%), mental disorders (34.93%) and cardiovascular diseases (11.65%). Excess mortality is a very serious problem of the public health. The increased mortality in 2020 and 2021 was closely related to the pandemic, as direct COVID-19 victims accounted for the majority of the observed increases in mortality. However, attention should be paid to the growth in mortality related to other causes, mainly mental disorders, for which mortality increases most rapidly, which requires immediate action. Key messages: The increased mortality in 2020 and 2021 was closely related to the pandemic, as direct COVID-19 victims accounted for approximately 90% of the observed increases in mortality in Poland.
In the group of no-related with COVID-19 deaths the highest increases were recorded for mortality due to cardiovascular diseases, neurological diseases and mental disorders.

Background:
Binge drinking by adolescents in Belgium is an increasing problem, according to emergency physicians who have recently alerted society about the increasing numbers of adolescents admitted to hospital due to acute alcohol intoxication (AAI). Until now, only estimations of the prevalence of AAI in adolescents are known and research about potential risk factors has not yet been conducted in Belgium.

Methods:
To gain more insight into the prevalence, medical characteristics, and context of AAI, a retrospective study in hospitals in the city of Antwerp was conducted. Medical charts of 10 to 18year-old patients admitted with AAI between 2015 and 2021 were investigated and analysed.

Results:
Between 2016 and 2021, 547 adolescents with AAI were admitted to 5 of the 8 hospitals in Antwerp. In the University Hospital of Antwerp (n = 177) mean age at admittance was 15.9 years. Older patients had a significantly higher BAC than younger patients (U:2357, 1, p-value: <0.001). In 10% of the patients combined drug use was proven and in this group, BAC was significantly lower (U:209, 1, p-value: <0.001). 60% of the patients were transmitted to the hospital by ambulance and in 31% the ambulance was assisted by specialised medical care. In 18% of the cases, the police were involved. The results of the other hospitals are not yet known at the time of submission but will be presented at the EPH conference.

Conclusions:
According to the data so far, younger patients and patients with comorbid drug use are admitted with a lower BAC, which could be seen as a potential risk factor. This should be considered in developing preventive measures like sensitization. Moreover, in a noteworthy percentage, ambulances, specialized care, and police are involved, which contributes to high medical and social costs. However, data addressing demographics and the context of AAI were mostly missing. Therefore, prospective research is required to further investigate potential risk factors for AAI. Key messages: A significant amount of adolescents with AAI are admitted in the city of Antwerp every year, with a mean age of 15.9 years old, which is below the legal alcohol age.
Considering the high prevalence of AAI and the major impact it has on adolescents health and medical and social costs, it is necessary to decrease the prevalence of binge drinking in adolescents.